That's oh-be-GUY-n, not oh-be-GIN, as some (primarily people from Texas) would like to refer to my chosen profession. Although, working in this field can sometimes cause one to develop a penchant for gin...hmmm.

Friday, February 04, 2011

Office Dos and Don'ts

When I am not on call and juggling office visits and catching babies, I am still working in the office seeing both OB and GYN patients every single day of the week. I realize that most of you spend only a fraction of that time in any physician's office, and frankly, we can tell. Here are some helpful hints to make your day at the GYN go a bit more smoothly:

Ob/Gyn Office *Dos*1. Do make an early appointment. Whenever possible, make your appointment the first appointment of the morning or the first appointment after lunch. Trust me on this one and see below.2. Do arrive for your appointment at least 10-15 minutes early. I know, I know, why would you want to show up early when you just *know* you are going to be in the office for *hours* on end. Here's why: The Snowball Effect. Invariably, as is required by the office, your insurance, or pencil pushers from various state and local agencies, you will be asked to fill out some kind of form upon your arrival. These are usually not mind-shatteringly difficult, but they can take time. Then the receptionist has to verify your information, make sure your insurance is still good, find your chart, and send it down the line to the MA/RN who will be bringing you into the office. The MA then fills in any new information, takes your vitals, asks the reason for your visit, and takes you to the room. Imagine what happens when you are "just 15 minutes" late for your appointment, everything that has to be done gets done further and further away from your appointment time. Before you know it, you are in the exam room 30 minutes after your appointment time, and if you think your schedule is thrown off, multiply that by 12-15 patients in a half-day. If all of them are even 5 minutes late for their appointment time, it creates a significant backlog for the physician to overcome. We're good, but we can't reverse time. It's just not feasible.3. Do know your personal and medical history. Be sure that you have approximate dates of any surgeries or hospitalizations that have occurred in the last few years. Know what body parts you do and do not have. Know what medications (and their doses) you are taking, for the love of all that is holy! I have no idea what birth control pills are in the pink rectangular package, and will not be able to divine it easily. Have a tentative idea of when your last period happened. I also have no idea what is in your medical history unless you bring your records to me to look at or have them sent to the office *before* your appointment, so please don't wave a dismissive hand and mumble something about how "it's all in there somewhere."4. Do bathe. Applying soap and water to your body sometime in the 24 hours before the appointment is considered common courtesy. I really don't care if your legs or any other areas are shaved, hair maintenance really doesn't concern or bother me in the least, but the courtesy of bathing is much appreciated.5. Do know what you want to accomplish. Write down the questions that you have or issues that you want to address at your appointment. In the hustle of the office routine, you will probably forget something. Keep a little list on a piece of paper or on your phone to review...and I stress *little.*

Ob/Gyn Office *Don'ts*1. Don't make a routine appointment for an out of the ordinary problem. This, of all things, is my number one pet peeve when it comes to office visits. If you are feeling depressed, your libido is in the toilet, your uterus is falling out, or you feel like you are bleeding to death every month, even if it *is* just about time for your pap smear, please, please, PLEASE don't call the office to make an "annual exam" appointment. Believe it or not, GYN physicians do more than just pap smears. If you want to see the doctor for a problem, make an appointment for such. Here is something you may not realize: You do *not* have to disclose to the scheduler *what kind* of problem you are having! Simply stating you have a problem you would like to discuss with the physician is totally adequate and spares you any embarrassment you may feel. Annual exam appointments are usually given about 10 minutes, but problem appointments can be scheduled for 15 minutes-30 minutes. This means you get more time with your physician to discuss treatment options and formulate a plan to get you feeling better. In the same vein, don't save up all of your problems for your annual exam; there is only so much we can do in an annual exam. Change your birth control? Yes. Change your birth control, cure your depression, diagnose your infection, and evaluate abnormal bleeding? Not so much. Scheduling the appropriate kind of appointment sets up a "win/win" situation for all involved.2. Don't expect to get an immediate answer/treatment/cure after one visit. Some problems (like infections) are easy to solve, but some problems are more complex and require data gathering and imaging studies. Your initial appointment may need to be followed by a secondary appointment in order to assimilate information and assess treatment efficacy. You may not have all the answers after seeing your physician one time, but I can assure, you will be headed in a definitive direction for treatment.3. Don't be rude to the office staff. They are there to do a job, and when you get seen, how you get seen, and certain office policies (like late policies) are totally out of their control. We all work together as a team, and you can bet that if you are a raging b*tch to my MA, I am going to hear about it before I step foot in the room. I can't guarantee a warmed speculum in those cases, either (I KID, NO HATE MAIL, PLEASE!!) On the flip side, if our staff is rude to you we want to know about it, so please share your experience with us.4. Don't expect your physician to (do even more) work for free. Trust me when I say that much of the "behind the scenes" work that we do goes uncompensated. It is common courtesy to inform you of your lab results over the phone (usually our nurses or clinical staff will do this), however, if you want to discuss the interpretation of your labs or formulate treatment plans based on the lab results? Make an appointment. Physicians' clinical opinions are based upon what we spent years learning; this is our professional service, and we deserve to be compensated for services rendered.5. Don't attempt to dictate your own treatment. Dr. Google is great for answers in the middle of the night, but printing sheaves of paper dictating how you *think* you should be evaluated/treated is incredibly off-putting. I value an educated patient, and appreciate when my patients "do their homework." This is not the same thing as demanding of a physician a specific test or treatment that you happen to think you may need. We want to collaborate with you about your care, and have spent years of training learning how to do this. Our knowledge is not so easily replaced by We.b.M.D. or W.ik.ipe.d.ia.

Please remember that most patients have NO IDEA how the office works. things that seem obvious to you are not obvious to others. I know that I learned from this post things I never knew before:1. Appointments have varying lengths. Not once, in my 40+ years of living, has an office staff ever said "I have you scheduled for 10 minutes." or "I have you scheduled for 20 minutes." All I get is a start time, I have no idea any appointment is different from any other.Perhaps you could train your office staff to ask things like "Is this for an uncomplicated annual exam, or are there additional issues you'd like to discuss with the doctor?" when scheduling. Seems like a simple change that would solve much of that issue.2. I had no idea that the staff does not factor in paperwork as part of the appointment. Everyone has paperwork. Instead of expecting patients to magically *know* to show up before you tell them to, you could build that time into the schedule. If someone tells me my appointment is at 4:30 - I take them at their word and show up at 4:30. Patients are not mind readers. If you want me there at 4:20 - tell me to be there at 4:20.Communication is key, and both of these issues could be greatly helped by the office better communicating with patients.

Brown Recluse~ It is not that we don't (often!) address concerns at annual examinations, and of course your physician should always ask if you have any concerns at your appointment. However, if you are coming to the doctor for a problem and just scheduling an annual exam, it sets up the wrong way right from the start. You may not have to get "all the way undressed" for a problem check appointment, either. I know that patients don't know this...which is why I wrote it in the blog. :) Thanks for reading...

Anon~ I know! That is what I said at the beginning of the post! ;) Glad that the post gave you some insight into how the office works. Our office staff does ask the pt. routine appointment or problem check, and they also explain that the appointment time is "blank," please arrive 15 minutes early to update paperwork. Our appointment reminder cards say this, as well. I agree that communication is key!

Dr. Whoo... just found you and managed to read through your archives well into 2009 before my kids woke up from their naps.

I am so relieved to find your blog. I'm a CBE/doula and birth junkie, and so many of the places I frequent online publish pages and pages of "doctors are evil" and "they love to slice" and whatnot, and to be straight up honest, my experiences attending birthing women don't always leave me feeling warm and fuzzy for the person with OB/ at the end of their name. What I'm getting around to saying though is that I appreciate your candor, giving a glimpse into the practice of at least one physician who bristles at the negative stereotypes perpetuated about your specialty. Not only that but it seems you are genuinely concerned about the why of this phenomenon.

The story about the mom whose baby crashed and needed the emergency c-section under general anesthesia had me reaching for the tissues... your humility in feeling like you'd done a "bad" job when the family was so quick to thank you... that is the stuff truly empathetic and effective OBs are made of. Looking forward to reading along even more!

Your post was very helpful. Do all doctor's offices run this way? It seems that I've had some doctors (and I've had MANY ob/gyn's) with incompetent and/or rude staff. No info was given about how the office works unless I ask - and even then I never got a straight answer from the main secretary. It sounds like you have a well-run office. This is not true of all doctor's offices, however. As much as I try to be a considerate patient, the doctor needs to make sure his/her staff is well trained in communication.

I would add : Please don't lie to the nurse while she's rooming you as to the reason for the visit.

My nurse has been with me for many years and is very well trained as to what I want to do for any particular type of appointment. The equipment I want will be laid out before I go in. It wastes her time and sometimes my supplies if I go in there to find that you weren't completely honest with her.

So, your bathing suggestion has me a little nervous... I can pretty much guarantee a shower the morning of an appointment but I can no longer always get in a second within an hour or so of my appointment with the whole juggling of 3 young children I have going on. So, there may be a slight "womanly fragrance" going on- especially at the end of pregnancy. That's ok, right? Do I need to be nervous about that?

I found your post rather insulting. You are pretty much saying, "don't bother me. You are not worth more than 5-10 minutes of my time on any given day."

I have specifically heard women complain about their OB visits when they have to repeadetly come back for minor issues that could be resolved in appointment; albeit, this might slightly over the maximum allowed for the usual appointment. Patients do not want to keep going to their OB when they are generally healthy. It's a waste of time and money. For the few that make all their issues known to the intake nurse/clerk, not everything mentioned may trickle down to the physician, and the intake person might not schedule wisely. Not all office staff has the medical knowledge necessary to predict how long an appointment will take.

As for me, I don't complain about any issues to my OB beyond anything life threatening. I don't want to be that patient who is "frequent" because of little things or the one who says during my routine exam, "oh yeah, I bleed through a tampon/pad every hour for two days while on my period out of fear of the OB. I don't think patients want to bother their OBs, and they might not know whether something is minor or serious. They just wait until their routine exam.

One of my friends recently got married. She wanted to go on BC (she was a virgin). She went a month before her yearly exam. She was a little pissed off that things couldn't be done together (prescribed birth control and have a yearly) even though this is what she said to the staff when she made the appointment were her intentions of the visit. That's just ridiculous to me. It's one month off. Why should she have to come in again if the BC for the first month goes well? Ultimately, she won't be going back to her provider after that.

Lindsey~ I am really touched by your comment. Thank you for taking the time to read and to approach this blog with an open mind. We *aren't* all evil knife sharpeners! Hope to dialog with you more in the future! :)

Anon 2/4, 5:07~ Always happy to hear from a fellow Ob/Gyn in the trenches, thanks for the support!

19lt70~ Glad to hear that this post helped! I can't say that *all* physician offices are run this way, but the few that I have worked in are very similar. You do find rude and uncommunicative staff members in the best of offices, and I bang my head regularly over inappropriately scheduled (by the scheduler) appointments. Communication is the key to moving forward.

ER's Mom~ OMG, yes! How could I forget that one? Especially in an office with EMR, have to go back and replace the entire template...frustrating!

Anonymous~ No, nothing to be nervous about at all! If you saw what I posted, I had the "within 24 hours of your appointment caveat." Showering that morning is well within that time frame. And of course, normal "womanly" fragrance developed over the course of the day is no issue at all.

mamadoc ~ Amen! As ER's mom said, we do them all-the-friggin-time. We charge a $25 form fee and the office staff collects them. We do not do them at the appointment. Total waste of *everyone's* time.

Amy in OH~ Thank you! Glad to be back! You would be amazed, simply amazed.

Speculative Speculum ~ I found your post rather insulting. You are pretty much saying, "don't bother me. You are not worth more than 5-10 minutes of my time on any given day."

While I hate that you found the post "insulting," I am puzzled as to how you came to this conclusion about how making your trip to the GYN more "efficient" translates to the patient is unworthy of a physician's time.

It's a waste of time and money.Perhaps the issue is that you think that physicians should give their time, the time of the other patients on the schedule, and their expertise away for free...since it isn't worth anything. I can't tell you what happens with these multiple and vague "friends" of yours of which you speak, but I doubt that minor medical issues would require more than one or two visits. More severe problems or treatment/medication follow ups certainly require (necessarily) multiple appointments and possibly exams.

For the few that make all their issues known to the intake nurse/clerk, not everything mentioned may trickle down to the physician, and the intake person might not schedule wisely. Not all office staff has the medical knowledge necessary to predict how long an appointment will take.

You are totally right about a scheduler/secretary having little medical knowledge about what appointment would require how much time, *however* they do know that a consultation for a problem can be put in a 30 minute slot, whereas the annual exam is in a 10 minute slot. The resposibilty lies upon the patient for taking charge of what they need out of their visit that day. It really is key to inform the intake RN or MA all issues you wish to address at the appointment, this helps the physician be best prepared to help you.

I don't think patients want to bother their OBs, and they might not know whether something is minor or serious. They just wait until their routine exam.

I agree that patients may or may not know if their concerns are serious, but they also cannot possibly expect for everything to be solved and tied up in a neat little bow within 15, 20, or even 30 minutes. I disagree that physicians find that their patients bothersome if they present with multiple different visits for other concerns. It is far better to return until the problem is adequately resolved than to just "suck it up" until the next annual exam.

One of my friends recently got married. She wanted to go on BC (she was a virgin). She went a month before her yearly exam. She was a little pissed off that things couldn't be done together (prescribed birth control and have a yearly) even though this is what she said to the staff when she made the appointment were her intentions of the visit. That's just ridiculous to me. It's one month off. Why should she have to come in again if the BC for the first month goes well? Ultimately, she won't be going back to her provider after that.

While inconvenient for your friend, true, you can't blame that one on the OB/GYN. She will find this issue wherever she goes due to *insurance coverage.* If you try to have your annual exam any earlier than a year and a day past the time of your last exam, insurance will not cover the cost of the exam and your friend would have had to pay roughly $200 in order to avoid being "inconveieneced." So while it sucks, this isn't the physician's doing, and they are being improperly blamed by your friend. Just sayin'...

Do... read the medical records you told the patient to send from the previous doctor.

Don't ... cause unnecessary pain to the patient.

More than 20 years ago I had to see a new dr in a new city I'd recently moved to, because of an abnormal pap, because I was a DES daughter (I *do* hope you know what that means without resorting to Google) ... and after he'd begun the exam he asked a question that made it quite clear he hadn't bothered to look at the records. With me spread open, he riffled through the folder, and then gave me such a rough exam that I literally could not sit down afterwards for several hours.

And, gosh, I'd arrived 20 minutes early to fill out his office paperwork, and showered that morning, and all that. Guess I got that oh-so-rare GYN who hates women.

They always ask me what type of birth control I use. I always tell them "My husband has azoospermia." To which case I get either a) dumb stare b) Oh, is that a kind of spermicide? or c) oh, so you're trying to get pregnant.

I find this extremely insulting, especially when I have to explain what it means in really small words. Then I go into the doctor's office, and she reads the notes (definitely has not read the chart) and either a)asks me "what does no sperm mean?" b) tells me I need to take care of and respect my body by taking bc c) asks me, so if you get pregnant, that's good right? or d) tells me I just need to relax. That last response didn't give me much confidence in her medical knowledge as how would ME relaxing suddenly make my HUSBAND develop sperm?? grr. If you have any tips for how I can deal with this infuriating office staff, I would appreciate it.

10 minutes for an annual?? One of the things I adore about seeing my CNM is that she isn't so tightly scheduled that she can't talk to me. When I was pregnant some of my checkups were that fast, but the annual exams were a lot less pressured.

I also am not fond of the front office in that office. Rude, taciturn, and unfriendly. When I saw a job advirtized in that office my Dh wanted me to apply and I said "Oh hell NO, I wouldn't last a month!"

Now that I know what goes on behind the scenes in the doctor's office, I'm always trying to explain it to frustrated patients who wonder why in the world their doctor is running behind. It makes a lot of sense once you know!

Good advice for us patients, definitely. Thanks for reminding me of the people on the other side of the speculum.

I would like to point out, though, that there does need to be some consideration shown in the opposite direction. When I was pregnant with my second child, I had to arrange a babysitter for my toddler (usually my mother on her one day off a week), my husband had to take a 1/2 day off work to drive me (I can't drive due to a brain injury), and then I had to spend almost half a day sitting there in the office waiting -- EVERY TIME. So forgive me that once I showed up five minutes late. Prior to that, I had never waited LESS than two hours past my appointment time to see the doctor (and sometimes as much as five hours!) for three to five minutes for my OB check. The one time I came five minutes late because my husband got nabbed on his way out of work for an important question, the office staff tried to turn me away, saying that it wouldn't be fair to the other patients if one could just "show up whenever" and be seen. I have to confess I was a bit touchy and asked to the waiting room at large if anyone there had the appoinments after mine, or if the doctor was behind enough my turn hadn't even come yet. Guess what? The doctor was running his usual two hours behind, so the receptionist decided that "just this once" she could allow me the priviledge of waiting another two hours to be seen.

I understand tight scheduling, dwindling profit margins, emergencies, and all that jazz, but routinely double- and triple-booking appointments so that you're HOURS late every time is disrespectful and wasteful of your patients' time, too. My husband is also a busy professional and used every scrap of his vacation time taking me to those doctor appts, leaving one two days for him to take off after the birth with pay (he had to take the other eight as unpaid leave). The occasional huge wait is understandable; the constant huge delay is unconscionable. And even that would have been bearable if the doc even pretended to actually care about my pregnancy or health instead of treating any and all questions about my rather high-risk pregnancy as an annoyance and interruption. If only there had been another high-risk practice in town! Grrr.

I'm sure you're not one of those docs, but thanks for letting me vent about the insensitive ones who are.

Just came across your blog today and really enjoyed this post! Thank for writing it! I spend a lot of time in various doctor's offices and take pride in the fact that I am a polite person to EVERYONE involved in my care. Even so, this list helped open my eyes to some other things that I can do to make their lives easier! I'm looking forward to reading through your back posts!

Dude, I always want to address you by your real name when I write comments (admittedly, although it has been a very long time! since I commented!). I think you are so brave to endure some of the comments that your posts elicit, and I'm so proud of you for your honesty here. Also, this post was really helpful! It never occurred to me to warn the front desk when making my appointment for an annual exam that I have a problem (if I do). I do agree with a previous commenter that it might be helpful if more front desks were to ask at the time of making the appointment if we are having any out-of-the-ordinary issues that need to be discussed, but I also realize that it is impossible for that to happen since most people schedule annual exams well in advance of their own awareness of a problem happening (I'm not one of those people, because I know I'm unreliable if I make an appointment a year in advance - I'd rather call around the time I'm due and hope an appointment time opens up). Anyway, I love you, friend, and I hope you are doing well, feeling appreciated, and know that I think of you often and think it is incredibly cool that you are doing the work that you do. You get to see miracles happen every day! But you also have to endure a miraculous amount of crap!

Hmmm...with my family practice doctor it was always a much longer appointment for my annual - a full 30 minutes.

Now that I alternate the gyno onco with the gyno I have a real hard time convincing them it is NOT just an annual. I know it is going to take time. He always has to review several pages of case history and tests. I feel bad that I am the case that puts him further behind but I swear I try.

If you have advice other than telling them succinctly I see him and my onco on alternating 6 months I would love to hear it!

Oh yeah, and the last two times I saw him was in relation to the mass they found in my MRI. I was scheduled for a 10 minute appointment (his office has it printed on the form you hand to the nurse). I know I personally spent 30 minutes each time plus the time on the phone and doing paperwork.

I can, however, say I was freshly showered both times and arrived 15 minutes early the second time. The first time they called and said, "When can you get here?"

APPLAUSE APPLAUSE APPAUSE !!!!!! I am an FNP and I swear I love my job and I love my patients but when I see "URI" on my schedule and I go in and they say "oh no...I wanted to talk about my rectal bleeding" I just want to throw my schedule up in the air !!!

Well I been gooing to my ob-gyn since my first child and now its my third I met a new nurse named Lauren, I told the first nurse to get my doctor to fill out this form for my gym membership, so lauren comes in with an attitude telling what she can't do and crap trying to tell me aboyt exercise I told her I dontwork out while pregnant and she also insulted my skin vitiligo I never want to see her ever she was very very very rude